Breast Cancer: Warning Signs, Symptoms, Treatment

Types of breast cancer

There are various types of breast cancer. Depending on the type of cells breast cancer can be divided into various types. The types of breast cancer include:

• Paget’s disease- it is one of the rare forms of breast cancer. During this cancer, the nipples and areola of the breast are affected by the cancer cells.
• Inflammatory breast cancer- It is one of the most aggressive forms of breast cancer. Breast cancer is often caused due to obstructive cancer cells in the skin’s lymph cells. The patient often complains of redness, swelling, pitting, and dimpling of the breast skin.
• Infiltrating ductal carcinoma (invasive)- These cancers are formed in the milk ducts, Most of these cancers forms in ducts or lobules. The cancer will spread rapidly from the origin to other tissues or nearby tissues of the breast.
• Lobular carcinoma- it accounts for about 10-15% of breast cancers. During this cancer, the lobule of the breast is affected and spread to surrounding breast tissue.
• Lobular carcinoma in situ- it is a precancerous condition, during which there is an abnormal mutation in the lobular cells of the breast.
• Ductal carcinoma in situ- it is a non-invasive breast cancer, during which the cancer cells are confined to the ducts in the breast and have not invaded the surrounding breast tissue.
• Triple-negative breast cancer- it accounts for about 15% of all breast cancer. It is called triple-negative breast cancer because these cancer cells are not associated with all three tumor markers (which include estrogen receptor, progesterone receptor, and HER2 receptor). These cells show negative to all three tumor markers hence making it difficult to diagnose and treat
• Phyllodes tumor- it is a very rare form of breast cancer that affects the connective tissue of the breast. In majority of the cases, these tumors are benign.
• Angiosarcoma- during this cancer, there is cancer growth in the lymphatic vessels or blood vessels in the breast.

Causes for breast cancer

In majority of the cases, breast cancer is caused due to mutation in the genes. The most common well-known genes which will cause breast cancer are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). It is estimated that about 5-10% of the people who are diagnosed with breast cancer is due to gene mutation which is passed from generation to generation.

Risk factors associated with breast cancer

There are various risk factors that can contribute to breast cancer. They include:

• Age- the incidence is higher as we grow older, however, it can affect females of all age groups.
• Gender- although, breast cancer can affect both men and women. The incidence of breast cancer is higher in females compared to men.
• Personal history of breast cancer- a patient who was diagnosed with breast cancer in the past.
• Family history of breast cancer
• Inherited genes that can increase the risk of breast cancer.
• Obesity
• Women who have never conceived
• Too much alcohol intake
• Post-menopausal hormone therapy
• Radiation exposure

Symptoms of breast cancer

The symptoms and severity associated with symptoms vary from person to person. The symptoms of breast cancer include:

• Abnormal breast lump noticed in either one breast or both breasts.
• Change in size, shape, and contour of the breast
• Abnormal discharge from the nipple of the breast which includes- blood discharge, pus, or fluid discharge from the nipple.
• Inverted nipple
• Redness or pitting of the skin of the breast
• Peeling, scarring, flaking of the pigmented area of the skin surrounding the nipple-areola, and crusting of the breast skin
• Change in the appearance of the skin
• Pain in the breast
• Lump or swelling of the lymph nodes that drains from the breast

Staging of breast cancer

The staging of breast cancer can be done in different ways. The stage of breast cancer can be done based on their size and how much it has spread to other parts of the body. The staging can be done through 5 stages. They include:

• Stage 0- it is also called ductal carcinoma in situ. It is an early stage of breast cancer. During this stage, the cancer is confined to the ducts in the breast and has not spread to nearby tissue.
• Stage 1- during this stage, the size of the tumor is < 2cm or 2cm in size. The tumor has not affected any of the lymph nodes.
• Stage 2- during this stage, the size of the tumor ranges from 2-5cm in size. The tumor has spread to the nearby lymph nodes. The tumor has not spread to the distant lymph nodes.
• Stage 3- during this stage, the size of the tumor has increased to >5cm in size. The tumor has spread to several lymph nodes.
• Stage 4- during this stage, the cancer can spread to distant organs of the body which include the liver, bone, brain, and lungs. The tumor has spread to distant lymph nodes.

Diagnosis of a breast cancer

The diagnosis of breast cancer can be done by these steps. They include:

• Breast self-examination- breast self-examination can be done by the person on their own at home at any time. During this examination, the person should stand in front of a mirror or can lie down in a supine position and examine their breasts. The person should initially look at their breast for symmetry, the appearance of the breasts, and any discharge from the nipple area. Later the person should palpate (touch and press) the breasts to look for any abnormal lumps in the breasts, pain, or any abnormal discharge from the nipples. If the patient notices any abnormalities in the breasts during the examination, one should consult the doctor immediately.
• Physical examination- During the physical examination, the doctor will examine the breasts of the patient thoroughly to look for any abnormalities in the breast. In case of abnormalities, in order to confirm the condition, the doctor will advise the patient to undergo a couple of tests and investigational scans. They include:
• Investigational scans- they include ultrasonography of the breast, breast mammography, MRI of the breast, and PET scan of the whole body. These scans will help us to evaluate the size of the tumor, their appearance, if the tumor has invaded (spread) to other parts of the body.
• FNAC- during this test, the doctor takes a small sample from the abnormal area of the breast and sends it for pathological studies.
• Tumor markers of the breast

Treatment for breast cancer

The treatment regimen for breast cancer depends on several factors which include the stage of breast cancer, and the overall condition of the patient. The treatment options include:

• Breast cancer surgery- operations used to treat breast cancer include:
  • Lumpectomy- during this procedure, the surgeon removes the abnormal lump found in the breast and sent for pathological studies. This procedure is also called breast-conserving surgery. This procedure is usually advised for the small size tumor, and which are benign in nature.
  • Mastectomy- during this procedure, the surgeon removes the entire breast which includes the removal of lobules, fatty tissue, ducts, and including nipple and areola (simple or total mastectomy).
  • Mastectomy + sentinel lymph node biopsy- during this procedure, the surgeon removes the entire breast along with the lymph node that is first to receive the lymph drainage from the tumor and sends it to the pathology department.
  • Mastectomy + axillary lymph node dissection
  • Removal of both breasts.
  • Breast reconstruction
• Radiation therapy
• Chemotherapy
• Hormonal blocking therapy- they include goserelin, tamoxifen, aromatase inhibitors, and ovarian suppression or ablation
• Targeted drug therapy or biological therapy- they include bevacizumab, trastuzumab, and lapatinib.
• Immunotherapy
• Supportive palliative therapy

Complications associated with breast cancer

The complications associated with breast cancer are listed below:

• Recurrence
• Pain in the breast
• Spread of cancer to other parts of the body
• Complications associated with radiation therapy, chemotherapy
• Weakened immune system.

Prevention of breast cancer

Although, breast cancer cannot be prevented completely. However, there are a few measures that will help in minimizing the risk of breast cancer. They include:

• Have a regular follow-up with the doctor, in case there is a family history of breast cancer
• Avoid alcohol intake
• Exercise regularly
• Minimize the post-menopausal hormone therapy
• Maintain a healthy weight and diet
• Regular breast cancer screening
• Breastfeeding
• Breast self-examination regularly
• Lifestyle modifications 

The survival rate for breast cancer

The survival rate for breast cancer depends on various factors, which include the age of the patient, race, stage of the patient, and overall condition of the patient. According to the research studies, the overall 5- year survival rate for breast cancer is approximately 90%.